I. BACKGROUND AND OBJECTIVES OF THE CNRU PROGRAM In January of 1979, The National Institutes of Health (NIH) issued a Request for Applications (RFA) for core grants as a means of encouraging a multidisciplinary approach to clinical nutrition research. 2/3 This solicitation was designed to complement the on going NIH-supported research grants and training awards and to . promote good health by disseminating new nutrition research findings to physicians, other health professionals, and the public. More specifically, the CNRU initiative is designed to provide a milieu for nutritional research, training, and education through coordinated effort, intellectual stimulation, and use of shared resources. The objectives of the program are to: Create or strengthen foci in biomedical research institu- 2 Request for Applications: Core Grants for Clinical Nutrition Research Units (CNRUs), NIH Guide Supplement for Grants and Contracts, January 26, 1979. 3The initial recommendation of core center support for clinical nutrition research, arose from an ad hoc Nutrition Program Advisory Group to the National Institute of Arthritis, Metabolism, and Digestive Diseases (NIAMDD), now the National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases (NIADDK). The Institute issued a Request for Applications for CNRUS in November, 1978. When the NIH Nutrition Coordinating Committee (NCC) supported this approach in January, 1979, a superseding interinstitute grant was announced. Currently, both the NIADDK and the National Cancer Institute (NCI) fund CNRUS. order to develop new knowledge about specific nutrients in health, human development, and the prevention and treatment of disease. o Strengthen training environments in order to improve the education of medical students, house staff, practicing physicians, and paramedical personnel in clinical nutrition. o Enhance patient care and promote good health by focusing attention on clinical nutrition and generating nutritional information for the public. Currently, the NIH supports seven CNRUs; five centers are funded by the National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases (NIADDK) and two by the National Cancer Institute (NCI). In combination, the NIADDK and NCI have directed $9,302,831 to the Units since the start of the program1; another $2,729,674 is projected to be spent in FY 1983. Appendix A provides the complete funding history for all seven Clinical Nutrition Research Units. 4Sum of actual funding totals for FY 1979 through FY 1982. Educational programs for medical students, house staff, practicing physicians, and paramedical personnel; Nutritional support services; and O Public information activities. Although the NIH has traditionally sponsored some of the aforementioned activities through research or training awards, the CNRU grant program is unique in its emphasis on shared resources and services. This stipulation has proven especially valuable in promoting multidisciplinary interaction, which advances understanding of nutritional sciences. Just as persons involved in biochemistry, physiology, endocrinology, and other sciences must work closely together to achieve breakthroughs in fundamental knowledge in nutrition, those involved in the appropriate medical specialties and subspecialties (i.e. internal medicine, gastroenterology, obstetrics, pediatrics, and surgery) must cooperate to rapidly integrate research findings into clinical applications. CNRUS, therefore, are one creative means by which clinical nutrition research is being effectively advanced within the modern organizational structure of medical research and practice. CNRU sharing of facilities, particularly core nutrition laboratories, has also helped increase the number of new multidisciplinary research projects in clinical nutrition and related areas. An average of 23 clinical nutrition research protocols (ranging from 7 to 40) are now active at each Unit. This focus on clinical nutrition research has positively influenced the training of medical students as well as the day-to-day practice of clinical medicine in each of the participating institutions. A third benefit of the CNRU shared facilities approach has been its ability to attract additional support, both from Federal and nonFederal sources. This mechanism has helped reduce the likelihood of any Unit becoming dependent on a single source of funds for its continued operations. For example, all CNRUS have obtained outside funds for educational programs and Nutritional Support Services. While such activities are required of each Unit, they may not be supported from NIH-program funds. In other areas, CNRUs provide temporary salary support for recently trained investigators or investigators new to nutrition research. This new investigator funding has proven highly effective in attracting young scientists to conduct clinical nutrition research, complementary to ongoing activities of the group. New investigators also have assumed major faculty commitments, facilitated interdisciplinary participation, and significantly lessened the Directors' burden of Unit administration. Following 2 years of CNRU stipend, the investigators are supported The NCI and NIADDK regularly monitor and evaluate the progress of CNRUS in reaching their goals through review of Unit reports, annual meetings, and site visits. In 1981 and 1982, site visits were conducted at all seven Units by representatives from the sponsoring Institutes as well as non-NIH clinical nutritionists.5 Future visits also are planned to reassess CNRU activities and accomplishments. Reports of site visits as well as other CNRU activities to date have documented the significant accomplishments of the Units; highlights of these achievements are presented herein. As a result of the program, it appears that: nutrition is being effectively integrated as a component of a broad spectrum of research projects; nutrition courses are being integrated into the affiliated medical school curricula; residents from various disciplines are rotating through nutrition "services;" and nutrition education materials are being developed for professionals 5Scientists from the Veterans Administration and United States Department of Agriculture Nutrition Center were invited to participate in site visits during 1982. |